Clindamycin Outpatient Dosing
For outpatient treatment in adults, clindamycin should be dosed at 300-450 mg orally every 6 hours (four times daily) for most infections, with the higher end of this range (450 mg) reserved for more severe presentations. 1, 2
Adult Outpatient Dosing
Standard Dosing by Infection Severity
- For uncomplicated skin and soft tissue infections: 300-450 mg orally four times daily (every 6 hours) is the recommended dose 1
- For more severe outpatient infections: Use 450 mg every 6 hours rather than 300 mg to ensure adequate coverage 2
- Maximum single oral dose: Should not exceed 600 mg 1
Duration of Therapy
- Most skin and soft tissue infections: 7 days is sufficient for uncomplicated cases 1
- Complicated infections: May require 10-14 days depending on clinical response 1
- Beta-hemolytic streptococcal infections: Must continue for at least 10 days 2
Important Clinical Considerations
- Clindamycin should only be used when local MRSA resistance rates are <10%, as higher resistance rates compromise efficacy 1
- Check for inducible resistance in erythromycin-resistant MRSA strains before prescribing 1
- Take with a full glass of water to avoid esophageal irritation 2
- Discontinue immediately if significant diarrhea develops, as this may indicate Clostridioides difficile infection 2, 3
Pediatric Outpatient Dosing
Standard Dosing for Children Who Can Swallow Capsules
- For serious infections: 8-16 mg/kg/day divided into 3-4 equal doses 2
- For more severe infections: 16-20 mg/kg/day divided into 3-4 equal doses 2
- For MRSA skin and soft tissue infections: 30-40 mg/kg/day divided into 3-4 doses 1, 4
Practical Considerations
- Capsules are not suitable for children who cannot swallow them whole - use clindamycin palmitate oral solution instead 2
- Dose based on total body weight regardless of obesity 2
- The capsule formulation does not provide exact mg/kg doses, so oral solution may be necessary for precise dosing 2
Common Pitfalls to Avoid
- Underdosing is a critical error: Using 300 mg three times daily instead of four times daily reduces efficacy significantly 1
- GI side effects are dose-dependent: The 600 mg dose causes significantly more severe and prolonged diarrhea (5 days vs 3 days) and stomach pain (7 days vs 4 days) compared to 300 mg 3
- Reserve oral clindamycin as a second-line option when possible, as 98% of patients experience some GI side effects 3
- Do not use for infections requiring gram-negative coverage - clindamycin has no activity against aerobic gram-negative rods like E. coli 5
When to Reassess
- Clinical improvement should be evident within 48-72 hours 1
- If no improvement occurs, consider inadequate source control, resistant organisms, or alternative diagnoses 1
- For abscess-associated cellulitis, ensure adequate drainage has been performed, as antibiotics provide limited benefit without source control 1